Conifer Health Solutions
EES Retro-Authorization Clinician
Conifer Health Solutions, Frisco, Texas, United States, 75034
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EES Retro-Authorization Clinician
role at
Conifer Health Solutions
Job Summary The Revenue Cycle Management Clinician for the Retro-Authorization Solution is responsible for all clinical retro‑authorization activities associated with patients financially cleared through the Patient Access Support Unit (PASU) and/or the Center for Patient Access Services (CPAS). The clinician coordinates with ordering physicians and/or facility staff to secure the necessary prior payment authorization utilizing applicable payer criteria.
Essential Duties and Responsibilities
Performs retro‑service authorization reviews to obtain payment authorization for both inpatient and outpatient services; abstracts fact‑based clinical information to support retro‑authorization utilizing applicable nationally recognized and payer‑specific criteria; communicates timely the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.
Spends a minimum of 2.5% of time on quality control and audit processes, participates in department projects to improve Conifer and client scorecard metrics, and provides feedback on workflow or procedural improvements.
Demonstrates proficiency in the use of multiple electronic tools required by Conifer and its clients.
Collaborates with internal and external customers (facility patient access and physician offices) to prevent future disputes; identifies potential process gaps and recommends solutions to CAS leadership; follows up with payers when a response is not obtained within 30 days via phone, email, or fax.
Other duties as assigned.
Knowledge, Skills, and Abilities
Ability to work independently and self‑regulate in compliance with deadlines.
Proficiency in applying nationally and payer authorization criteria.
Excellent customer‑service skills, including written and verbal communication.
Intermediate proficiency in Microsoft Office (Excel and Word).
Critical thinking, problem‑solving, and independent decision‑making.
Professional interaction with clinical and non‑clinical partners.
Prioritization and multitasking with efficiency.
Advanced conflict resolution skills.
Effective communication at all levels.
Research skills regarding payer retro‑authorization guidelines and applicable regulatory processes.
Education / Experience
Valid nursing license (Registered or Practical/Vocational).
Minimum 1–2 years as a pre‑authorization, utilization review nurse and/or clinical team lead/supervisor in a payer or acute‑care setting; preferably medical‑surgical or critical care/ED or equivalent healthcare experience.
Certificates, Licenses, Registrations
Preferred: LPN or RN license.
Physical Demands
Ability to lift 15–20 lbs.
Ability to travel approximately 10% of the time to client and/or Conifer office sites.
Ability to sit and work at a computer for extended periods while conducting retro‑service medical necessity reviews.
Work Environment
Typical call‑center environment requiring a desk, chair, and office equipment such as computer, telephone, printer, etc.
Compensation
Pay: $64,168 – $96,262 annually (depends on location, qualifications, and experience).
Management‑level positions may be eligible for sign‑on and relocation bonuses.
Benefits
Medical, dental, vision, disability, life, and business travel insurance.
Paid time off (vacation & sick leave) – minimum 12 days per year, accrued at approximately 1.84 hours per 40 hours worked.
401(k) with up to 6% employer match.
10 paid holidays per year.
Health savings accounts, healthcare & dependent flexible spending accounts.
Employee Assistance Program; employee discount program.
Voluntary benefits: pet insurance, legal insurance, accident and critical illness insurance, long‑term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID‑19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in undue hardship.
Tenet participates in the E-Verify program. E-Verify: http://www.uscis.gov/e-verify information is available below.
Seniority Level Associate
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care and Medical Practices
#J-18808-Ljbffr
EES Retro-Authorization Clinician
role at
Conifer Health Solutions
Job Summary The Revenue Cycle Management Clinician for the Retro-Authorization Solution is responsible for all clinical retro‑authorization activities associated with patients financially cleared through the Patient Access Support Unit (PASU) and/or the Center for Patient Access Services (CPAS). The clinician coordinates with ordering physicians and/or facility staff to secure the necessary prior payment authorization utilizing applicable payer criteria.
Essential Duties and Responsibilities
Performs retro‑service authorization reviews to obtain payment authorization for both inpatient and outpatient services; abstracts fact‑based clinical information to support retro‑authorization utilizing applicable nationally recognized and payer‑specific criteria; communicates timely the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.
Spends a minimum of 2.5% of time on quality control and audit processes, participates in department projects to improve Conifer and client scorecard metrics, and provides feedback on workflow or procedural improvements.
Demonstrates proficiency in the use of multiple electronic tools required by Conifer and its clients.
Collaborates with internal and external customers (facility patient access and physician offices) to prevent future disputes; identifies potential process gaps and recommends solutions to CAS leadership; follows up with payers when a response is not obtained within 30 days via phone, email, or fax.
Other duties as assigned.
Knowledge, Skills, and Abilities
Ability to work independently and self‑regulate in compliance with deadlines.
Proficiency in applying nationally and payer authorization criteria.
Excellent customer‑service skills, including written and verbal communication.
Intermediate proficiency in Microsoft Office (Excel and Word).
Critical thinking, problem‑solving, and independent decision‑making.
Professional interaction with clinical and non‑clinical partners.
Prioritization and multitasking with efficiency.
Advanced conflict resolution skills.
Effective communication at all levels.
Research skills regarding payer retro‑authorization guidelines and applicable regulatory processes.
Education / Experience
Valid nursing license (Registered or Practical/Vocational).
Minimum 1–2 years as a pre‑authorization, utilization review nurse and/or clinical team lead/supervisor in a payer or acute‑care setting; preferably medical‑surgical or critical care/ED or equivalent healthcare experience.
Certificates, Licenses, Registrations
Preferred: LPN or RN license.
Physical Demands
Ability to lift 15–20 lbs.
Ability to travel approximately 10% of the time to client and/or Conifer office sites.
Ability to sit and work at a computer for extended periods while conducting retro‑service medical necessity reviews.
Work Environment
Typical call‑center environment requiring a desk, chair, and office equipment such as computer, telephone, printer, etc.
Compensation
Pay: $64,168 – $96,262 annually (depends on location, qualifications, and experience).
Management‑level positions may be eligible for sign‑on and relocation bonuses.
Benefits
Medical, dental, vision, disability, life, and business travel insurance.
Paid time off (vacation & sick leave) – minimum 12 days per year, accrued at approximately 1.84 hours per 40 hours worked.
401(k) with up to 6% employer match.
10 paid holidays per year.
Health savings accounts, healthcare & dependent flexible spending accounts.
Employee Assistance Program; employee discount program.
Voluntary benefits: pet insurance, legal insurance, accident and critical illness insurance, long‑term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID‑19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in undue hardship.
Tenet participates in the E-Verify program. E-Verify: http://www.uscis.gov/e-verify information is available below.
Seniority Level Associate
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care and Medical Practices
#J-18808-Ljbffr